We dont work hard enough on entitlement reform or overseeing the Fed.

Conservatives frequently wonder whether Republican politicians are reliable partners in their quest to reduce the size of government. And with good reason. But there is a parallel question that conservatives never ask: Are conservatives reliable partners in the Republican quest to reduce the size of government?

According to the Congressional Budget Office, nearly every dollar of growth in the size of government as a share of the economy — excluding interest on the debt — is a result of our health-care entitlements: Medicare, Medicaid, Obamacare, and related programs. Given that fact, youd think that a movement dedicated to shrinking government would devote the majority of its intellectual energy to reforming the health-care leviathan. Most of us have, instead, been content to endorse the latest proposal from Paul Ryan.

Paul Ryan is great — hes a hero of mine — but a conservative movement that can come up with a dozen plans for tax reform before dinner should be able to come up with two dozen plans for entitlement reform before lunch. Paul Ryan rose to prominence precisely because he took on a project in which others lacked interest.

Most Republican politicians these days come into office with a genuine desire to reduce the size of government. But they run into a number of problems, the most important being that many voters recoil at concrete efforts to reduce spending. And we face that problem, in turn, because conservatives havent sufficiently succeeded at building a grass-roots movement that is passionate about the biggest drivers of government growth.

In mid-March, conservatives will gather at the 2013 Conservative Political Action Conference, a three-day confab dedicated to advancing conservative principles and goals. CPAC is hosting over a hundred events, on a multitude of worthy topics. But does the American Conservative Union, CPACs sponsor, believe that health spending is a serious problem? Apparently not: The group isnt hosting a single event related to health-care policy. Nothing on Obamacare, nothing on Medicare reform, nothing on resisting the expansion of Medicaid in the states, nothing on the increasing unaffordability of health insurance for the middle class. Nothing.

Lest you think Im unfairly picking on CPAC, the other major conservative gathering of the year — the National Review Institute Summit — also neglected to include a session on health-care policy.

For the progressive movement, by way of comparison, universal single-payer health care has been a tier-one policy goal for a hundred years. As a result, the average politically informed left-winger knows a lot more about these issues than his counterpart on the right does. Democratic politicians, in turn, receive a steady stream of support from the progressive grass roots when it comes to building the single-payer edifice, brick by brick.

Health care is not the only area of conservative under-investment. The U.S. Federal Reserve, headed by Ben Bernanke, has built up a $3 trillion balance sheet in the course of subsidizing Washingtons deficit spending. The central bank intends to continue to purchase $85 billion a month in U.S.-government debt and mortgage-backed securities for the foreseeable future.

But this cannot go on forever, at least not without destroying the savings of ordinary Americans and making ordinary goods less affordable. On the other hand, unwinding the Feds Latin American–style "quantitative easing" will be extremely difficult without crashing the economy or driving up the governments borrowing costs. All of this is happening without meaningful congressional oversight.

Here, at least, the libertarian wing of the conservative movement has been quite active. Ron Paul, for years, has asked Congress to audit the Fed. And CPAC, to its credit, is hosting a talk by Richard Fisher, president of the Federal Reserve Bank of Dallas, who is a prominent critic of Bernankes policies. But many conservatives have disdained monetary hawks as eccentric and quixotic. Others, understandably, find financial policy too abstract or complex to warrant the investment of time and effort.

These blind spots in todays conservatism stem from the movements historical roots. Bill Buckley and his NR compatriots built modern American conservatism in the 1950s and early 60s, before the Great Society was enacted. And many of those who now lead the conservative movement came of age during the presidency of Ronald Reagan, when, as Ramesh Ponnuru and Jim Pethokoukis have noted, the public-policy challenges were very different from the ones we are facing today.

We conservatives often shake our fists impotently at the fact that government seems to grow no matter what we say or do. But until we invest more of ourselves into reforming the biggest drivers of government growth, we will have only ourselves to blame.